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Rehabilitation Benefits Highly Motivated Patients: A Six-Year Prospective Cost-Effectiveness Study

  • Birgitta E. M. Grahn (a1), Lars A. Borgquist (a2) and Charlotte S. Ekdahl (a3)


Objectives:To compare the six-year outcome of a multidisciplinary rehabilitation program with continued care within primary care in terms of health-related quality of life and cost-effectiveness. Furthermore, predictors of total costs to society were examined.

Methods:A prospective, matched, controlled, six-year follow-up was designed. The study included 236 patients (42 men, 194 women) nineteen to sixty-one years of age with prolonged musculoskeletal disorders. The intervention comprised a four-week multidisciplinary rehabilitation and an active one-year follow-up based on a bio-psycho-social approach. The control group received continued care within primary care. The main outcome measures were quality of life measured using the Nottingham Health Profile, motivation identified by an interview and patient-specific total costs to society. Differences in mean costs between groups and cost-effectiveness were evaluated by applying nonparametric bootstrapping techniques.

Results: Total costs per treated patient in the rehabilitation group and the control group were £43,464 (SD=31,093) and £44,123 (SD=33,333), respectively (p=.896). Multidisciplinary rehabilitation improved quality of life somewhat more cost-effectively. Motivation was revealed as a predictor of total costs.

Conclusion: In the long-run, the evaluated multidisciplinary rehabilitation improved the highly motivated patients' quality of life most cost-effectively. The latently motivated patients may require rehabilitation, which is less intensive and with a longer duration, to improve their health in a whole-person perspective. The burden of prolonged musculoskeletal disorders to society was reaffirmed. Motivation could be a predictor of total costs, a factor which has to be taken into account in the examination procedure.



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Altman G. 1991. Practical statistics for medical research. London: Chapman & Hall
Becker N, Bondegaard TA, Olsen AK, et al. 1997; Pain epidemiology and health related quality of life in chronic non-malignant pain patients referred to a Danish multidisciplinary pain center. Pain. 317: 393400.
Cherkin D. 1998; Primary care research on low back pain. The state of the science. Spine. 23: 19972002.
Croft P, Macfarlane A, Thomas E, Silman A. 1998; Outcome of low back pain in general practice: A prospective study. BMJ. 316: 13561359.
Deardorff W, Rubin H, Scott D. 1991; Comprehensive multidisciplinary treatment of chronic pain: A follow-up study of treated and non-treated groups. Pain. 45: 3543.
Drummond MF, O'Brien B, Stoddart GL, Torrance GW. 1997. Methods for the economic evaluation of health care programmes. 2nd ed. Oxford: Oxford University Press
Feuerstein M, Lynne M, Zastowny T, Barron BA. 1994; Chronic back pain and work disability: Vocational outcomes following multidisciplinary rehabilitation. J Occup Rehabil. 4: 229251.
1996; Goossens MJEB, Rutten-van Mölken MPMH, Leidl RM, et al. Cognitive-educational treatment of fibromyalgia: A randomised clinical trial, II: Economic evaluation. J Rheumatol. 23: 12461254.
Goossens MEJB, Rutten-van Mölken MPMH, Kole-Snijders AMJ, et al. 1998; Health economic assessment of behavioural rehabilitation in chronic low back pain: A randomised clinical trial. Health Econ. 7: 3951.
Grahn B, Borgquist L, Ekdahl C. 2000; Motivated patients are more cost-effectively rehabilitated. A two-year prospective controlled study of patients with prolonged musculoskeletal disorders diagnosed in primary care. Int J Technol Assess Health Care. 16: 849863.
Haldorsen EM, Grasdal AL, Skouen JS, et al. 2002; Is there a right treatment for a particular patient group? Comparison of ordinary treatment, light multidisciplinary treatment, and extensive multidisciplinary treatment for long-term sick-listed employees with musculoskeletal pain. Pain. 95: 4963.
Heikkilä H, Heikkilä E, Eisemann M. 1998; Predictive factors for the outcome of a multidisciplinary pain rehabilitation programme on sick-leave and life satisfaction in patients with whiplash trauma and other myofascial pain: A follow-up study. Clin Rehabil. 12: 487496.
Hildebrandt J, Pfingster M, Saur P, Jansen J. 1997; Prediction of success from a multidisciplinary treatment programme for chronic back pain. Spine. 22: 9901001.
Korthals-de Bos I. 2002. Economic evaluations in musculoskeletal disorders. PhD thesis. Institute for Research in Extramural Medicine, Vrije University, Amsterdam, the Netherlands
Lanes T, Gauron E, Spratt K, et al. 1995; Long-term follow-up of patients with chronic back pain treated in a multidisciplinary rehabilitation programme. Spine. 20: 801806.
Lindgren B. 1998; The economic impact of musculoskeletal disorders. Acta Orthop Scand 69 (Suppl 281).
Lundvik Gyllensten A. 2001. Basic body awareness therapy. Assessment, treatment and interaction. PhD thesis, Department of Physical Therapy, Lund University, Lund, Sweden
Maslow AH. 1987. Motivation and personality, 3rd ed. Revised by Frager R, Fadiman J, McReynolds C, Cox R. New York: Harper & Row, Publishers, Inc
Meerding WJ, Bonneux L, Polder JJ, Koopmanschap MA, van der Maas PJ. 1998; Demographic and epidemiological determinants of health costs in Netherlands: Cost of illness study. BMJ. 317: 111115.
Mäntyselkä PT, Kumpusalo EA, Ahonen RS, Takala JK. 2002; Direct and indirect costs of managing patients with musculoskeletal pain-challenge for health care. Eur J Pain. 6: 141148.
Reeve J. 1997 Understanding motivation and emotion, 2nd ed. Orlando: Harcourt Brace College Publishers: 5.
Roxendal G. 1995 Psykosomatiskt inriktad sjukgymnastik (Psychosomatically-oriented physiotherapy). In: Sivik T, Theorell T, eds. Psykosomatisk medicin (Psychosomatic medicine). Lund: Studentlitteratur: 296312 (in Swedish).
Sanders C, Egger M, Donovan J, Tallon D, Frankel S. 1998; Reporting on quality of life in randomised controlled trials: Bibliographic study. BMJ. 317: 11911194.
Skouen J, Grasdal A, Haldorsen E, Ursin H. 2002; Relative cost-effectiveness of extensive and light multidisciplinary treatment programs versus treatment as usual for patients with chronic low back pain on long-term sick leave. Spine. 27: 901909.
Smith R. 1993 Psychology. Minneapolis/St. Paul: West Publishing Co: 464493.
Straaton K, Wrigley M, Fine P. 1993; Vocational rehabilitation for persons with arthritis and musculoskeletal disorders: Fact or fantasy? Arthritis Care Res. 6: 13.
Torstenssen TA, Ljunggren AE, Meen HD, et al. 1998; Efficiency and costs of medical exercise therapy, conventional physiotherapy, and self-exercise in patients with chronic low back pain. A pragmatic, randomised, single-blinded, controlled trial with 1-year follow-up. Spine. 23: 26162624.
Wadell G. 1987; A new clinical model for the treatment of low back pain. Spine. 12: 632644.
Wiklund I. 1989 The Nottingham Health Profile. Swedish version. In: Hunt S, McKenna S, eds. European guide to the Nottingham Health Profile. The European Group for Quality of Life and Health Measurements. Manchester: Galen Research & Consultancy: 7794.
Williams AC, Richardson PH, Nicholas MK, et al. 1996; Inpatient vs. outpatient pain management: Results of a randomised controlled trial. Pain. 66: 1322.



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